Citation Nr: 21067106 Decision Date: 11/03/21 Archive Date: 11/03/21 DOCKET NO. 15-42 768A DATE: November 3, 2021 REMANDED Entitlement to service connection for hypertension is remanded. Entitlement to service connection for peripheral neuropathy of the right lower extremity is remanded. Entitlement to service connection for peripheral neuropathy of the left lower extremity is remanded. Entitlement to service connection for peripheral neuropathy of the right upper extremity is remanded. Entitlement to service connection for peripheral neuropathy of the left upper extremity is remanded. REASONS FOR REMAND The Veteran had active service from December 1965 to November 1967, with service in the Republic of Vietnam. These matters were previously denied by a June 2020 Board decision. The Veteran appealed this decision to the U.S. Court of Appeals for Veterans Claims (the Court). In June 2021, the parties agreed to a Joint Motion for Partial Remand (JMPR), which vacated the June 2020 Board decision regarding these matters. Remand is necessary to comply with the JMPR and ensure VA meets its duty to assist the Veteran. 1. Entitlement to service connection for hypertension is remanded. The Veteran contends that he is entitled to service connection for hypertension secondary to service-connected heart disease and sleep apnea. See November 2015 Notice of Disagreement. Service connection may be established on a secondary basis for a disability that is proximately due to, or the result of a service-connected disease or injury. 38 C.F.R. § 3.310 (a). Establishing service connection on a secondary basis requires evidence sufficient to show that a current disability exists and that the current disability was either caused by or aggravated by a service-connected disability. 38 C.F.R. § 3.310(a); Allen v. Brown, 7 Vet. App. 439 (1995). Causation and aggravation are independent concepts and should have separate findings and rationales. Atencio v. O'Rourke, 30 Vet. App. 74 (2018). An opinion to the effect that one disability "is not caused by or a result of" another disability does not answer the question of aggravation. El-Amin v. Shinseki, 26 Vet. App. 136, 140-41 (2013). In September 2015, a VA examiner found that the Veteran's heart disease or medications to treat heart disease less likely than not caused or aggravated his hypertension. However, the September 2015 VA examiner did not opine as to whether the Veteran's service-connected sleep apnea caused or aggravated his hypertension. Remand is warranted to obtain a VA medical opinion as to whether the Veteran's service-connected sleep apnea, or medication taken to treat this condition, has proximately caused or aggravated his hypertension. 2. Entitlement to service connection for peripheral neuropathy of the right lower extremity is remanded. 3. Entitlement to service connection for peripheral neuropathy of the left lower extremity is remanded. 4. Entitlement to service connection for peripheral neuropathy of the right upper extremity is remanded. 5. Entitlement to service connection for peripheral neuropathy of the left upper extremity is remanded. The Veteran contends that he suffers from peripheral neuropathy of the upper and lower bilateral extremities, which is related to herbicide exposure or secondary to his service-connected heart disease. See March 2016 Notice of Disagreement. A May 2019 VA examiner stated that there were no available medical records of evidence at the time of the examination to substantiate a diagnosis of peripheral neuropathy. However, the examiner did not address a January 2014 electromyogram (EMG) which revealed bilateral lower extremity peripheral neuropathy. Remand is necessary to provide the Veteran with VA examination to determine the nature and severity of any peripheral neuropathy of the upper and lower bilateral extremities, and to determine whether this condition was proximately caused by or aggravated by the Veteran's service-connected heart disease, or medication taken to treat this condition. The matters are REMANDED for the following action: 1. Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran's hypertension is at least as likely as not proximately due to service-connected disability, or aggravated beyond its natural progression by service-connected disability, to include sleep apnea and medication for sleep apnea. (a.) The VA examiner must provide rationale to support the opinions. (b.) The VA examiner must provide separate findings and rationales relating to causation and aggravation. 2. Schedule the Veteran for a VA examination for his peripheral neuropathy of the left upper extremity, right upper extremity, left lower extremity, and right lower extremity. The examiner must review the claims file. If the examiner determines that a diagnosis of neuropathy cannot be made, the examiner must discuss any contradictory evidence of record, including a January 2014 electromyogram (EMG) which revealed bilateral lower extremity peripheral neuropathy, and the Veteran's own reports of symptoms. If a diagnosis cannot be provided but the Veteran's condition manifests in symptoms that cause functional impairment, then the examiner should consider them a "disability" for the purpose of providing the requested opinions below. The examiner is asked to provide a response to the following: Is the disability at least as likely as not proximately due to service-connected heart disease or medication taken for heart disease? Is the disability at least as likely as not aggravated, i.e., worsened beyond its natural progression, by service-connected heart disease or medication taken for heart disease? (a.) The VA examiner must provide rationale to support the opinions. (b.) The VA examiner must provide separate findings and rationales relating to causation and aggravation. JENNIFER HWA Veterans Law Judge Board of Veterans' Appeals Attorney for the Board C. Casey, Counsel The Board's decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.